November 18, 2006
Medicine is a science, although, as I’ve been recently reminded, not an exact one.
I’ve held off for over a week before posting anything here because I wanted to report some concrete facts. But it now appears that the facts are going to take some time to work out.
The endoscopic ultrasound and lymph node biopsies were performed on Thursday, November 9. The procedure went very well. Once again, the pathologists were unable to find any evidence of cancerous cells in the nearby lymph nodes, subject to a final determination. Consequently, the preliminary pathology report indicated my staging as “T2Nx.”
Code legend:
T2 = The “T” refers to the tumor. The “2” indicates that it has invaded the fourth layer of the esophagus wall. This is good news. It could have been much worse. As it is, the surgeons consider this a “superficial” attachment.
Nx = The “N” refers to lymph node involvement. The “x” indicates an unknown. Two possibilities: A “1” in place of the “x” would indicate that the cancer has spread to nearby lymph nodes, and a “Ø” would indicate that it has not spread.
One glaring absence from the above code: The ominous “M” in place of the “N.” My guess is that the letter stands for “migration.” It denotes near or distant organ involvement. I’m so thankful that in my case the dreaded letter was not applicable.
The plan as of last Thursday afternoon was to do further testing on the biopsy samples and then issue the final pathology report, which, at least according to me, would prove once and for all that the “x” should be replaced by a “Ø.” That’s when the inexact part came into play.
Though the pathologists could not find any cancerous cells in the lymph nodes, neither did they find the indications they wanted to absolutely confirm their absence. So, on that level, we’re essentially back at square one.
For those of you keeping score at home, the diagnostic procedures have found the following: The CT scan indicated some questionable lymph nodes. The PET scan ruled them out. The final test, the actual biopsies, ruled them neither in or out. In effect, a draw.
The tumor board recommendation was to perform the surgery first if no lymph node involvement was found. If involvement was found, then to do the chemoradiotherapy first. The immediate problem is that neither condition is absolutely confirmed.
The biopsies are important now only as to the timing of the treatments. The members of the medical team will be debating the merits of each approach this coming week, and then make a final recommendation to me. Though I would prefer to do the surgery first, my current bet is that it will now follow the chemoradiotherapy.
Either way, it’s time to get this show on the road.
I’ve held off for over a week before posting anything here because I wanted to report some concrete facts. But it now appears that the facts are going to take some time to work out.
The endoscopic ultrasound and lymph node biopsies were performed on Thursday, November 9. The procedure went very well. Once again, the pathologists were unable to find any evidence of cancerous cells in the nearby lymph nodes, subject to a final determination. Consequently, the preliminary pathology report indicated my staging as “T2Nx.”
Code legend:
T2 = The “T” refers to the tumor. The “2” indicates that it has invaded the fourth layer of the esophagus wall. This is good news. It could have been much worse. As it is, the surgeons consider this a “superficial” attachment.
Nx = The “N” refers to lymph node involvement. The “x” indicates an unknown. Two possibilities: A “1” in place of the “x” would indicate that the cancer has spread to nearby lymph nodes, and a “Ø” would indicate that it has not spread.
One glaring absence from the above code: The ominous “M” in place of the “N.” My guess is that the letter stands for “migration.” It denotes near or distant organ involvement. I’m so thankful that in my case the dreaded letter was not applicable.
The plan as of last Thursday afternoon was to do further testing on the biopsy samples and then issue the final pathology report, which, at least according to me, would prove once and for all that the “x” should be replaced by a “Ø.” That’s when the inexact part came into play.
Though the pathologists could not find any cancerous cells in the lymph nodes, neither did they find the indications they wanted to absolutely confirm their absence. So, on that level, we’re essentially back at square one.
For those of you keeping score at home, the diagnostic procedures have found the following: The CT scan indicated some questionable lymph nodes. The PET scan ruled them out. The final test, the actual biopsies, ruled them neither in or out. In effect, a draw.
The tumor board recommendation was to perform the surgery first if no lymph node involvement was found. If involvement was found, then to do the chemoradiotherapy first. The immediate problem is that neither condition is absolutely confirmed.
The biopsies are important now only as to the timing of the treatments. The members of the medical team will be debating the merits of each approach this coming week, and then make a final recommendation to me. Though I would prefer to do the surgery first, my current bet is that it will now follow the chemoradiotherapy.
Either way, it’s time to get this show on the road.
posted by Explorer of The Universe at 1:45 PM
